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[Iatrogenic injuries of the cardia antireflux system]
A Lewandowski1, W Knast, M Strutyńska-Karpińska
1Katedry i Kliniki Chirurgii Przewodu Pokarmowego Akademii Medycznej we Wrocławiu.
Insights
Iatrogenic injury to the cardia antireflux system can cause esophageal strictures. Esophagogastric bypass surgery yielded the best results for treating these complex cases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Iatrogenic injury to the cardia antireflux system can lead to esophageal strictures.
- Previous surgeries for conditions like cardiospasm or duodenal ulcer (gastric resection B2) are common predisposing factors.
Purpose of the Study:
- To evaluate surgical management outcomes for patients with iatrogenic esophageal strictures.
- To identify the most effective reconstructive techniques for post-injury esophageal strictures.
Main Methods:
- Retrospective analysis of 18 patients with iatrogenic cardia antireflux system injury.
- Review of surgical interventions including reoperations, dilatation, and various reconstructive procedures (e.g., Merendino method, Heyrowsky method, jejunal bypass, esophagogastric anastomosis).
Main Results:
- All 18 patients presented with esophageal strictures, primarily in the abdominal and thoracic cardia regions.
- 16 patients required reoperations, with most needing one to three corrective surgeries.
- Esophagogastric bypass using a pedunculated jejunal graft demonstrated the most favorable outcomes.
Conclusions:
- Iatrogenic injury to the cardia antireflux system frequently results in complex esophageal strictures requiring surgical intervention.
- Esophagogastric bypass is an effective method for managing these challenging strictures, offering superior results compared to other techniques.
Abstract:
Among presented 18 patients with iatrogenic injury of the cardia antireflux system, 5 were females and 13 males aged 35-62 years of life. 13 cases were operated before for cardiospasmus, 5 had gastric resection B2 for duodenal ulcer. In consequence all the patients presented stricture of the thoracic lower and abdomen part of oesophagus. 16 patients required reoperations, 2 had dilatation. In 2 cases stricture were located in middle and lower part of oesophagus. In 4 cases in abdominal and supradiaphragmatic part of oesophagus, in 5 cases in abdominal part of oesophagus, and in 7 cases in the cardia. 11 patients required one corrective surgery, 4-two operations, and 1-three operations. As a final procedure: in 2 cases artificial oesophagus was formed with intestinal graft, in 8 cases the cicatrical part of the oesophagus was excised and replaced by a pedunculated graft by Merendino method, in 3 cases esophagogastric anastomosis were done using Heyrowsky method, in 2 cases bypass was made from pedunculated part of jejunum which connect the part of oesophagus above the narrowing with the prepyloric part of the stomach by the own method, in 1 case intrathoracic esophagogastric anastomosis was performed. The best results were obtained by oesophagogastric bypass.